219

Journal of Oral Science, Vol. 57, No. 3, 219-227, 2015

Original

Suture materials affect peri-implant bone healing

and implant osseointegration
Oscar Villa1), Staale P. Lyngstadaas1), Marta Monjo2), Maria Satué2), Hans J. Rønold3),
Christiane Petzold1), and Johan C. Wohlfahrt1)
1)Department of Biomaterials, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
2)Group of Cell Therapy and Tissue Engineering, Research Institute on Health Sciences (IUNICS),
University of Balearic Islands, Palma de Mallorca, Spain
3)Department of Prosthodontics, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway

(Received March 25, 2015; Accepted May 19, 2015)

Abstract: The aim of this study was to evaluate the
effects of the remnants of two suture materials on
osseointegration of titanium implants in a rabbit tibial
model. Calibrated defects were prepared in the tibia
of five Chinchilla rabbits. Filaments of nonresorbable
(NR) nylon or resorbable (R) chitosan were placed at
the bone to implant interface, whereas control sites had
no suture material. After a healing period of 4 weeks,
a pull-out test procedure was performed followed by
enzymatic analyses of the wound fluid and relative
quantification of mRNA levels for bone-related and
cytokine markers from the peri-implant bone. A trend
toward a reduced pull-out force was observed in the
NR group (NR: 23.0 ± 12.8 N; R: 33.9 ± 11.3 N; control:
33.6 ± 24.0 N). Similarly, the bone resorption marker
vacuolar type H+-ATPase was increased in the NR
group compared with that in the control group (P =
0.041). The R group showed trends for lower alkaline
phosphatase activity and osteocalcin expression and
higher total protein content and RNA compared with
the control group. In this submerged healing model,
peri-implant bone healing was marginally affected by
the two suture materials tested. However, there was
a tendency toward better osseointegration and lower
expression of bone resorption markers in the R group
Correspondence to Dr. Johan Caspar Wohlfahrt, Department of
Biomaterials, Institute of Clinical Dentistry, University of Oslo,
P.O. Box 1109, Blindern, NO-0317 Oslo, Norway
E-mail: j.c.wohlfahrt@odont.uio.no
doi.org/10.2334/josnusd.57.219
DN/JST.JSTAGE/josnusd/57.219
compared with the control group.
(J Oral Sci 57, 219-227, 2015)
Keywords: suture materials; chitosan; nylon;
dental implants; bone; wound healing;
osseointegration; biological complications.
Introduction
Foreign materials, such as cement remnants from the
supraconstruction, can sometimes lead to peri-implant
tissue complications (1). Theoretically, suture remnants
displaced toward the peri-implant bone may have a similar
negative effect on the peri-implant tissues. The choice of
suture material may potentially influence the outcome
of periodontal and implant procedures (2,3). The ideal
suture material should provide uncomplicated stable
primary wound closure without affecting the treatment
outcome negatively. However, suture materials often
seem to worsen the inflammatory response for a variety
of reasons (4); therefore, the selection of an appropriate
material is important (5,6). Materials that minimize
inflammatory reactions are preferred, particularly in an
environment, such as the oral cavity, where microbial
levels are high. Moreover, suture materials and their
metabolites might affect the healing process, particularly
after implant placement, and can also provide a route for
communication between the fixture and the oral cavity
(2). Moreover, the wicking effect of some suture types
can result in harbouring and transporting bacteria to
the depth of the wound; thus, evading the host defense
mechanism, resulting in local infection and subsequent
220
acute inflammatory reaction (6,7).
Suture materials are either resorbable (R) or nonresorb-
able (NR). They can also be classified into mono- and
multifilamentous or braided on the basis of their physical
configuration (8). Braided sutures provide easier
handling and better knot stability compared with mono-
filament types; however, they present a higher potential
for transmitting infections (9). Monofilament sutures
are usually NR, with few exceptions. Nylon consists of
a group of materials with the same chemistry, and it is
the most commonly used NR suture material (10). Nylon
sutures can be either monofilamentous or braided and
consist of synthetic polyamide polymer fibers (8). They
present clinically acceptable biocompatibility and a low
inflammatory response in infected wounds (4). However,
there are few R monofilament suture materials. Chitin is
a natural polysacharide (a poly-N-acetyl glucosamine)
commonly found in the exoskeleton of crustaceans,
cuticles of many invertebrates, and cell walls of fungi
(11). Chitosan is obtained by deacetylation of chitin.
Chitosan sutures are generally R and monofilamentous
and present excellent properties for surgical application
(12). They have been demonstrated to have antibacte-
rial (13-15) and anti-inflammatory (16) properties and
improve wound healing (17-19) and bone formation (20).
They also reduce bacterial rates by 100% (21). This is
an advantage as bacteria can penetrate along the suture
track, leading to an inflammatory tissue reaction (6). In
vitro studies have demonstrated that chitosan decreases
macrophage production of pro-inflammatory cytokines,
suppresses cyclooxygenase induction, and increases the
release of anti-inflammatory cytokines (16). Moreover,
clinical studies reported that it also improved wound
healing (17-19) and increased wound breaking strength in
a rat model (22). In a dog model, chitosan was shown to
promote migration of inflammatory cells into the deeper
wound area and increase formation of connective tissue
through increased production of collagen (23). Okamoto
(24) found fewer inflammatory cells migrating to the
wound site in the chitosan group and a trend to enhance
re-epithelialization. It also induced bone formation in
surgically created bone defects in an experimental animal
model but showed no indication of the same in the control
group (20). To the best of our knowledge, the influence
of suture remnants on peri-implant bone healing has not
yet been investigated. The aim of the present study was
to evaluate the effects of monofilaments of NR nylon and
R chitosan materials on peri-implant bone healing in a
validated animal model.
Materials and Methods
In vivo study
This study used five female chinchilla rabbits (Oryc-
tolagus cuniculus), 6 months old and weighing 3.0-3.5
kg (ESF Produkter Estuna AB, Norrtälje, Sweden). The
animals were kept in cages during the experimental
period. Room temperature was maintained at 19 ± 1°C,
and humidity at 55 ± 10%.
The experiment was approved by the Norwegian
Animal Research Authority. The procedures were
conducted in accordance with the Animal Welfare Act
of January 1, 2010, Section 13 and the Regulation on
Animal Experimentation of January 15, 1996.
The rabbits were sedated with 0.05-0.1 mL/kg subcu-
taneous (s.c.) fluanisone/fentanyl (Hypnorm, Janssen,
Belgium) and anesthetized with 2 mg/kg intravenously
(i.v.). Midazolam (Dormicum, Roche, Switzerland) 10
min before surgery. In case of signs of waking up, diluted
Hypnorm was injected i.v. slowly until adequate sedation
effect was achieved. Lidocaine/adrenaline (Xylocaine/
Adrenaline, AstraTech AB, Mölndal, Sweden) was
administered locally at the operation site. The operation
sites were depilated and washed with soft soap before
surgery. Animals were then placed on their backs on
the operating table and covered with sterile cloths, and
the operating sites were disinfected with chlorhexidine
gluconate 5 mg/mL (Klorhexidin, Galderma Nordic AB,
Uppsala, Sweden).
An incision was made on the proximal-anterior part of
the tibia, penetrating all soft tissue layers. The periosteum
was elevated and retained by a self-retaining retractor.
Four guide holes were made with a twist drill (Medicon
CMS, Tuttlingen, Germany), using a drill guide to ensure
standardized and correct positioning of the implants.
Implant beds were prepared using a custom-made
stainless steel bur (diameter 6.25 mm) mounted on a
slow-speed dental implant drill. Copious irrigation with
physiological saline solution was carried out during bone
preparation. Four sites were prepared in each animal
and then randomized to one of the three groups. Control
sites were left empty. In the two test groups, one of the
following suture materials were placed in the prepared
implant sites prior to implant placement (Fig. 1):
・NR monofilament nylon suture (Nylon 6/12, Dupont,
Wilmington, DE, USA) USP size 6-0.
・R monofilament chitosan suture (Medovant GmbH,
Mainz, Germany), USP size 6-0.
The suture filaments were carefully placed on the
prepared bone surface, perpendicular to the implant direc-
tion, using thin tweezers. Four 5-mm fibers were placed
at each implant site, avoiding fiber overlapping and over-

Fig. 1   Intrasurgical pictures showing the suture filaments placed
over the bone defect (a). The implant with a Teflon cap placed
over the test site (b).
filling. A coin-shaped, machined, titanium implant (6.25
mm in diameter and 1.95 mm in thickness), covered with
a Teflon cap to avoid bone overgrowth, and a preshaped
titanium maxillofacial bone plate (Medicon CMS) were
placed over the test and control sites and retained with
two titanium mini screws (1.2 × 3 mm, Medicon CMS).
The soft tissue was repositioned and sutured in place
with DexonII (Sherwood-Davis & Geck, Ballymoney,
UK). Following surgery, each animal received an s.c.
injection of 20 mL NaCl, warmed to body temperature,
and 0.02-0.05 mg/kg buprenorphin (Temgesic, Reckitt &
Colman, Hull, UK). A second s.c. injection of 0.05 mg/
kg Temgesic was administered at least 3 h after the first/
previous Temgesic injection. Health status was monitored
throughout the study period, and the operation sites were
examined daily until wound healing was complete. After
a healing period of 4 weeks, the rabbits were euthanized
using fluanison/fentanyl (Hypnorm) 1.0 mL i.v., followed
by pentobarbital (Mebumal, Rikshospitalets Apotek,
Norway) 1 mL/kg body weight i.v. An incision was made
through the soft tissue up to the tibial bone immediately
after euthanization. The titanium plate covering the
implants was exposed and removed. A hole was made in
the center of the PTFE cap with a hypodermic syringe,
and pressurized air was applied to remove the caps and
expose the reverse part of the titanium implant.
Tensile force test procedure
The excised tibial bone was fixed and leveled for the
tensile force test. The pull-out test was performed with
a tensile test machine (Zwicki; Zwick, Ulm, Germany)
equipped with a 200 N load cell. A pull-out jig was
attached to the screw hole on the backside of the implants,
perpendicular to the implant test surface, and the load
was applied until the implant detached from the bone.
The force applied was recorded on a load versus
displacement plot. The implant-bone attachment was
evaluated immediately after euthanasia, so that the results
were not influenced by drying. It was possible to analyze
221
whether shear forces skewed the test from the load versus
displacement plot recorded. An immediate drop in the
curve indicated little influence of shear forces, whereas a
tapering curve indicated a greater influence.
Wound fluid analyses: lactate dehydrogenase activity,
alkaline phosphatase activity, and total protein
After implant detachment, two filter chromatography
paper discs (same size as the coins) were placed in each
drilled hole (proximal and distal) for 1 min to absorb
wound fluid. Samples were then transferred to microcen-
trifuge tubes containing 200 µL of phosphate-buffered
saline (PBS) and placed on ice until analysis was carried
out later the same day.
Lactate dehydrogenase (LDH) activity in the wound
fluid was used as a marker for tissue necrosis (25). Spec-
trophotometric analysis of LDH levels was carried out
by first incubating 50 µL of wound fluid and 50 µL of the
reaction mixture at 25°C for 30 min and then measuring
the oxidation of NADH at 490 nm in the presence of
pyruvate, according to the manufacturer’s kit instruc-
tions (Cytotoxicity Detection kit, Roche Diagnostics,
Manheim, Germany).
Alkaline phosphatase (ALP) activity was used as an
indicator of mineralization around the titanium implants
(26). An aliquot of 25 µL of wound fluid in duplicate was
assayed for alkaline phosphatase activity by measuring
the cleavage of p-nitrophenyl phosphate (Sigma, St.
Louis, MO, USA) in a soluble, yellow end product that
absorbs at 405 nm. A volume of 100 µL of this substrate
was used. The reaction was stopped after 30 min in the
dark by adding 50 µL of 3 M sodium hydroxide. The
absorbance of the ceased reaction was read at 405 nm.
Similar to the samples, a standard curve with calf intes-
tinal alkaline phosphatase (CIAP, 1 U/µL); Promega,
Madison, WI, USA) was constructed by mixing 1 µL
of stock CIAP with 5 mL of alkaline phosphatase buffer
(1:5,000 dilution) and then preparing 1:5 serial dilu-
tions. Total protein in the wound fluid for each sample
was determined using a BCA protein assay kit (Pierce,
Rockford, IL, USA) according to the manufacturer’s kit
instructions.
RNA isolation and real-time RT-PCR analyses
A monophasic solution of phenol and guanidine thio-
cyanate (Trizol, Life Technologies, Carlsbad, CA, USA)
was used to isolate total RNA from the peri-implant bone
tissues attached to the extracted implants, which was
then quantified using a Nanodrop spectrophotometer
(Nanodrop Technologies, Wilmington, DE, USA) at 260
nm. The same amount of RNA (280 ng of the total RNA
222

isolated) was reverse transcribed to cDNA at 42°C for 60

min, using a High Capacity RNA-to-cDNA kit (Applied
Biosystems, Foster City, CA, USA) that contains oligo
and random hexamers. Each cDNA was diluted 1/4, and
the aliquots were frozen (-20°C) until the PCR reactions
were carried out.
The three housekeeping genes used were 18S ribosomal
RNA (18S rRNA), glyceraldehyde-3-phosphate dehy-
drogenase (GAPDH), and β-actin. The target genes were
Fig. 2   Tensile test measurements of implants. Box plots
vacuolar type proton ATPase (H+-ATPase), insulin-like
show the median value and distribution of the measurements
growth factor-1 (IGF-1), bone morphogenetic protein-2 for each group (n = 5). CTRL, control; NR, nonresorbable
(BMP-2), collagen-type 1 (Coll-1), interleukin-10 monofilaments; R, resorbable monofilaments.
(IL-10), IL-6, osteocalcin (OC), calcitonin receptor
(CalcR), tartrate-resistant acid phosphatase (TRAP), and
tumor necrosis factor-α (TNF-α). Primer sequences have
been published elsewhere (26,27). Real-time PCR was
performed in the Lightcycler 480 (Roche Diagnostics).
Each reaction contained 7 µL of LightCycler-FastStart
DNA Master SYBR Green I dye, 0.25 µL of sense and
antisense specific primers, and 3 µL of cDNA dilution
resulting in a final volume of 10 µL. The amplification
program consisted of a preincubation step for denatur-
Fig. 3   Picture of the bone defects after implant removal.
ation of the template cDNA (10 min, 95°C), 45 cycles of Resorbable (a) and nonresorbable monofilaments (b).
the denaturation step (10 s, 95°C), an annealing step (10 Arrows indicate filament location.
s, 60°C), and an extension step (10 s, 95°C). After each
cycle, fluorescence was measured at 72°C. A negative
control without cDNA template was used in each assay.
Real-time efficiencies were calculated from the slopes
provided in the LightCycler 480 software (Roche Diag-
nostics) using serial dilutions showing all the investigated
transcripts, high real-time PCR efficiency rates, and high
linearity when different concentrations are used. PCR
products were subjected to a melting curve analysis on
the LightCycler, and subsequently 2% agarose/TAE gel
electrophoresis to confirm amplification specificity, Tm, Fig. 4   LDH activity measured in the wound fluid collected
from the implant site. LDH activity was expressed as
and amplicon size, respectively. percentage of the control operated site, which was set
All samples were normalized by the geometric mean of to 100%. Values represent mean ± SEM (n = 5). CTRL,
the expression levels of 18S rRNA, GAPDH, and β-actin, control; LDH, lactate dehydrogenase; NR, nonresorbable
and fold changes were related to 4 weeks of implant monofilaments; R, resorbable monofilaments.
placement using the mathematical model described by
Pfaffl (28) as follows: ratio = Etarget ∆Cp target (mean control 4
weeks−sample)
/Ereference ∆Cp target (mean control 4 weeks-sample), where Cp is using the Student t-test. All analysis was performed on
the crossing point of the reaction amplification curve as SPSS program for Windows (Chicago, IL, USA) version
determined by the LightCycler 480 software. Stability of 17.0, and the overall significance threshold (α) was set
reference genes was calculated using the BestKeeper tool at 0.05.
(29). Thus, values were expressed as a percentage of the
control defects at 4 weeks, which were set to 100. Results
Tensile test
Statistical analysis Biomechanical evaluation of implants using the tensile
All data are presented as mean values ± SEM. Differ- test showed no significant differences between the
ences between the test and control groups were examined groups (Fig. 2). However, a trend toward a lower pull-out

Fig. 5   ALP activity, total protein, and specific ALP activity (corrected by total protein) measured in the wound
fluid collected from the implant site. Total protein content (expressed in microgram) extracted from each defect.
Values represent mean ± SEM (n = 5). ALP, alkaline phosphatase; CTRL, control; NR, nonresorbable monofila-
ments; R, resorbable monofilaments.
Fig. 6   Quantification of total RNA content (ng/defect)
isolated from the peri-implant bone tissues attached to the
extracted implants. Values represent mean ± SEM (n =
5). CTRL, control; NR, nonresorbable monofilaments; R,
resorbable monofilaments.
force was observed in the NR group (approximately 30%
decrease).
Macroscopic observation of the implant site and
wound fluid analyses
All implant sites showed uneventful healing, and no
adverse effects were observed. The implant was visu-
ally inspected after removal. All sites showed minimal
bleeding, regardless of the treatment group, after 4 weeks
(Fig. 3). R sutures were still present in all defects but
one (Fig. 3). There were no differences in the total LDH
activity, ALP activity, and protein content of peri-implant
wound fluid between the test and the control groups
(Figs. 4, 5). However, on calculating specific ALP
activity by correcting ALP activity with total protein
present in the wound fluid, a trend toward lower activity
was found in the R group (54% decrease) and NR group
(43% decrease) when compared with the control group
(Fig. 5). The R group also showed a trend for increased
total protein content (21-30%), when compared with the
NR and control groups (Fig. 5).
223
Gene expression analyses from peri-implant bone
tissue
No statistically significant differences in total RNA
content of bone tissue attached to the extracted implants
were found between the groups, although the R group
showed a trend toward higher total RNA content (Fig. 6).
There were no statistically significant differences in
gene expression markers related to bone formation, i.e.
BMP-2, Coll-1, OC, and IGF-1 (Fig. 7), between the test
and the control groups, although there was a trend toward
decreased OC expression in the R group compared with
the control group (P = 0.086).
The three markers related to differentiated osteoclasts
and bone resorption, i.e., H+-ATPase, TRAP, and CalcR,
were also investigated: Gene expression of H+-ATPase
was increased in the NR group compared with the control
group, and this was statistically significant (P = 0.041).
No such differences were found with regard to the
expression of TRAP and CalcR (Fig. 8).
The gene expression of pro-inflammatory (TNF-α and
IL-6) and anti-inflammatory (IL-10) cytokines was also
investigated, and no statistically significant differences
were found between the test and control groups (Fig. 9).
However, the mRNA levels of IL-10 were reduced in the
NR and R groups, although these were not statistically
significant (P = 0.069 and 0.125, respectively). There
was also a trend toward reduced expression of IL-6 in the
R group compared with the control group, and this was
also not statistically significant (P = 0.098).
Discussion
The present study shows that suture materials, such as
nylon or chitosan, may have an impact on early peri-
implant osseous healing. Although the results were not
conclusive, they suggest that processes like bone resorp-
tion and inflammation may be altered by the presence
of suture materials and that different materials may act
differently on these processes. Presence of NR material
224

Fig. 7   In vivo expression of bone formation related markers (BMP-2, Coll-1, and OC), and a bone repair marker
(IGF-1). Data represent fold changes of target genes normalized with reference genes (18S, GAPDH, β-actin),
expressed as a percentage of the control group set at 100%. Values represent the mean ± SEM (n = 5). BMP-2,
bone morphogenetic protein-2; Coll-1, collagen-type 1; CTRL, control; GAPDH, glyceraldehyde-3-phosphate
dehydrogenase; IGF, insulin-like growth factor-1; NR, nonresorbable monofilaments; OC, osteocalcin; R, resorb-
able monofilaments.

Fig. 8   In vivo expression of bone resorption related markers (H+-ATPase, TRAP, and CalcR). Data represent
fold changes of target genes normalized with reference genes (18S, GAPDH, β-actin), expressed as a percentage
of the control group set at 100%. Values represent the mean ± SEM (n = 5). CTRL, control; GAPDH, glyceral-
dehyde-3-phosphate dehydrogenase; NR, nonresorbable monofilaments; R, resorbable monofilaments; TRAP,
tartrate-resistant acid phosphatase.

Fig. 9   In vivo expression of inflammatory markers (TNF-α, IL-6, and IL-10). Data represent fold changes of
target genes normalized with reference genes (18S, GAPDH, β-actin), expressed as a percentage of the control
group set to 100%. Values represent mean ± SEM (n = 5). CTRL, control; GAPDH, glyceraldehyde-3-phosphate
dehydrogenase; IL, interleukin; NR, nonresorbable monofilaments; R, resorbable monofilaments; TNF-α, tumor
necrosis factor-α.

at the bone-implant interface decreased implant retention
to a greater extent than other groups and also resulted
in statistically significant higher gene expression of
the bone resorption marker H+-ATPase. The R group
showed a trend toward lower specific ALP activity and
OC expression, but this did not influence the outcome
of the biomechanical test used to assess bone-implant
attachment.
Although tissue reactions around nylon monofilament
sutures have been reported to be minimal (30), they can

elicit a foreign body tissue reaction in certain clinical
situations (31,32). In our study, visual inspection of the
bone defects after implant removal and measurement of
LDH activity indicated that nylon sutures did not induce
any adverse reactions at the bone-implant interface.
However, nylon suture remnants showed a trend toward
decreased implant attachment compared with chitosan
monofilaments. Moreover, increased gene expression of
H+-ATPase was observed in the nylon group. The vacuolar-
type proton pump (H+-ATPase) is present in the ruffled
membrane of osteoclasts and is involved in osteoclastic
bone resorption (33). Thus, the lower implant retention
observed in the NR group may be related to higher bone
resorption at the bone-implant interface. This might be
explained by the nature of the nylon sutures used in the
present experiment. The presence of NR filaments at
the bone-implant interface may interfere with the initial
phase of bone healing, and histological evaluation could
provide further insight into the osseointegration process
taking place at the interface. In the present study, the
bone-implant interface was disrupted on extraction of the
implants, and the samples were processed for enzymatic
and molecular analyses. Therefore, histological analysis
of the intact interface could not be carried out.
The chitosan-based R suture material used in this
study was still present in all defects, except for one site,
after a healing period of 4 weeks. The degradation time
of the chitosan material in this closed environment may
be longer than in an inflamed highly vascularized soft
tissue. Some R suture materials require longer periods to
degrade, even in infected or acidic environments (6,34).
As reviewed by Pillai et al. (35), several modifications
can be made to the polymerization degree and polymer
structure of chitosan such as etherification, esterifica-
tion, cross-linking, and grafting copolymerization to
enhance solubility. Moreover, the biodegradability of
chitosan fibers increases with degree of acetylation (36).
All these parameters should be taken into consideration
when selecting a suture for implant surgical procedures.
Although a suture with faster biodegradation rate might
be preferable when suturing peri-implant tissues, it may
result in rapid resorption at the wound causing loss of
wound stability that can potentially affect the osseointe-
gration process. Moreover, the degradation process leads
to different degrees of inflammatory response depending
on the suture material (8). A trend toward a higher
amount of total RNA and protein content was found in
the R group compared with the NR group. This may
reflect a proliferative stage (37) at the implant interface
and the presence of bone proteins at an early stage of
bone healing (26). These results may be explained by
225
the higher tissue reactivity and proteolytic enzymatic
degradation shown by the R material used in the present
experiment. Thus, biodegradation of chitosan fibers may
lead to a specific cell response that can influence healing
in the peri-implant tissues. Chou et al. (16) found that
chitosan-treated macrophages decreased expression of
pro-inflammatory cytokines (TNF-α and IL-6). In the
present study, a trend toward reduction of TNF-α and
IL-6 was also found in the chitosan group. Moreover,
a trend toward reduced expression of IL-10 was found
in our study, while increased production of IL-10 by
macrophages was reported by Chou et al. (16). Chitosan-
coated culture plates have been reported to upregulate
genes associated with Coll-1, osteopontin, osteonectin,
and OC in osteoblasts (38). Similarly, it has been shown
that chitosan-coated fibers increased cell attachment,
ALP activity, and the expression of osteopontin on pre-
osteoblasts, resulting in significant mineralization in a
3D construct (39) and new bone formation in a rabbit
calvarial model (40). Our in vivo experiment differs from
the in vitro results from Matthews et al. (38) and Yang et
al. (39) as the expression of Coll-1 was not modified, the
specific ALP activity was reduced, and a trend toward
reduction in the expression of OC was found. OC is a
marker for mineralization (41) and has been associated
with osseointegration (37). Thus, this observed trend
might be related to an ongoing remodeling in the peri-
implant bone tissue that takes place during the resorption
process of the suture material.
This study examined the effects of suture materials
on early wound healing and showed that sutures may
influence early peri-implant healing if filaments are left
in close proximity to the bone-implant interface. Further
investigations are required to determine the influence of
a broader number of sutures materials on peri-implant
bone healing.
Acknowledgments
This work was supported by the University of Oslo, the Norwe-
gian Research Council and the Ministerio de Ciencia e Innovación
del Gobierno de España (Ramón y Cajal contract to MM) and
NILS Science and Sustainability Programme (ES07 EEA Grants;
013-Abel-CM-2013). The authors have no conflicts of interest to
declare.
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